Oxygen

House of Bloods Ng’anda Yabulowa

 Is it really the end of May? Each time I travel abroad, I somehow expect time to reset to the day after we left when I get back home. Is it still May 22nd at home? This morning the students have rounds or operating theater observations while a group of us went to the Medaical Laboratory, called the Ng’anda Yabulowa – the house of bloods here. It might sound a little strange to call the Medical lab the house of bloods- but this is where people know they go to have a blood sample drawn and tested.

Here we met Rogers Moono and Lweendo Muchaili who showed us around the labs. They have many sophisticated instruments to test samples for red and white blood cell counts, types of white blood cells and specifically cells presenting CD4 –which are indicators either of anemia, infection or HIV/AIDS. In the microbiology labs they were staining for TB and malaria, and it was interesting for the students to see the application of staining methods they have practiced in class. In the labs here (much like in other places) the focus is on affordable, rapid, and reliable testing of the samples.

Lweendo Muchaili

Rogers Moono

After the tour of the labs, we stopped by the machine shop to visit Steve who has been fixing the oxygen concentrators with George Moono and others. There are 8 oxygen concentrators here at Macha, and before Steve arrived only 4 of them were working, and one was only increasing oxygen concentration by 2 % (so, really there were only 3 working). He has already fixed several of them so that now there are 8 concentrators working to 80-90% oxygen!  Next he is going to work on making them more humidity tolerant by adding an additional filter to the units. Humidity is a problem because if the filtering material in the concentrator gets wet, it is ruined - which is bad if your rainy season lasts from October to April (as it does here).

Steve and George and the Concentrator

Steve Fixing stuff

Steve’s project is really important for the hospital here. Dr. Thuma was talking to us about the health problems that most commonly lead to death, especially in children. One of the leading causes is Pneumonia. If the patient is treated with oxygen their chances of survival are quite high, but without oxygen many of the patients die. Macha hospital is too far from the large cities to get tanks of oxygen delivered to the hospital regularly, so they use oxygen concentrators to enrich the air (by filtering out nitrogen for those of you who are interested). So, Steve is not only working on fixing the machines that they have, but is also working to train the mechanics so that they are able to keep the concentrators running long after we leave.

Sunset (picture taken by Larry)

Speaking of leaving, we all depart this afternoon for our two night homestays in the villages! You can expect to see two of these (or at least we can) before you should expect to hear from any of us again! We are all excited to meet our new host families and see what village life is like!

The Spirits

The students had rounds in the hospital this morning, and class this afternoon. After class (to wake ourselves up) Larry and I took a walk to the old water tower and climed to the top. The view from the top is great! And it was just after most people had finished working and school was out, so there were people walking all over, it was fun to watch them making their way along the roads with water on their heads or driving their cows along.

Larry on the water tower, you can see a nice home in the distance behind him.

Caleb, Steve, Phil, Dan, Evan and Keane on the water tower.

Dr. Thuma has been inviting guests to come and visit with us and to share their perspective on aspects of life in Zambia. I shared yesterday about visiting the traditional healer, and we had a couple in to talk about courtship and marriage practices, David and Edine Hamulumbu. They told us not only about their own story, but also the practices of their children. Tonight we had Pastor Keith Mwaanga- the chaplain at the hospital, Mulenga Mukanu – the pharmacists at the hospital, and Ester Spurrier - a long time missionary in Macha. They talked with us about the role of traditional healers in traditional and modern Zambian society and gave us a primer in village life (so that we know what to expect this weekend).

David and Edine Hamulumbu visiting us to talk about Marriage and Courtship practices.

Dr. Thuma and Pastor Keith talking about Spirits.

All three of our guests tonight emphasized how important the spirit world is to Zambians (and to most African) people. They told many different stories that highlighted the activity and presence of spirits in us and affecting our lives. Ester said something that caught my attention: she said that we in western societies have divorced ourselves from the spirit world all-together, and that by doing this we loose significant connection or lack any depth in our connection to the Holy Spirit. We are clearly here in Zambia to learn, and I think it would be a mistake to spend too little time contemplating this thought. Just because something cannot be quantified with scientific instruments does not mean that it isn’t real, and if it is real, should we not be aware of it?

This may be what our home stay house will be like- we don't know yet!

Now: WARNING PARENTS! This weekend we are all going out into the villages and staying with a family there. So- you will not be getting e-mails or calls from us, and I won’t be posting pictures from Friday night until Sunday afternoon (our time). So, don’t worry if you don’t hear from us, we’ll be having fun in the village with our host families!

Ice Cream- STAT!

Urgent Message to the Families: Yesterday at the traditional healer, he told us of an interesting way to treat people who are too weak to come to see the doctor personally. He said that if a closely related agent of the ill person takes the medicine for the ill person, the distant ill person will feel better! So- can you all quickly run out and eat some ice cream and have a nice drink at Starbucks for us (or eat some cheese)? The only possible glitch is that Dr. Lomuno isn’t administering this remedy for us, but we’re all willing to risk it! We're all hoping to feel ice-creamed and Starbucked a little latter today- right?

Us on the Bus- the last time we had cheese...

The Magic of the Milky Way

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There are many little things that make living here at Macha feel like a special treat. There is ‘magically’ food on the table for us every day at breakfast lunch and dinner (yes, we do know the women who make the food for us, but for the first time in a long time, I am not making the majority of the food I am consuming) – AND at our tea time break from class. We can easily find friends to play with by walking down to the fires and playing a ‘pick-up’ game of Duck Duck Goose. Lost luggage magically arrives on the bus from Livingstone, everyone is friendly, and every night the Milky Way smiles at us from above.  ** I had written this before dinner, and after dinner Dan and Caleb came with the picture below! 

Thanks Dan and Caleb for the Milky Way picture!

 

Don't be fooled- tea time is serious business! They were all smiling once they had the rolls in their mouths!

Class today (day three) was a discussion of effectors of public health. We discussed education, income, economics, and equity. It is especially clear to all of us visiting here that healthcare and education are not equitably distributed across the world- or even within a country. I guess there are different ways to look at equity. Is it ‘fair and just’ to give education and healthcare only to those who can pay for it? It is easier to say so or work it out in an accounting book than it is to turn away a set of children from the school because they are simply too poor to afford to buy the books or the uniform. And yet, we are forced sometimes to make such hard decisions because both healthcare and education require some input of funds to function appropriately. So- our class discussion moved on to talking about some strategies that have worked to improve overall education and healthcare in different settings, hoping to pull some insights for successful strategies that might be applied in other locations. Again, it has been very valuable to have the perspective of Dr. Thuma who has considered and worked through these issues for many years.

Dr. Thuma (red shirt) our tireless instructor, ready leader, and translator for all things cultural or lingual.

The local primary school

This afternoon we visited one of the local traditional healers, Dr. Lomuno. Dr. Lomuno learned the arts of traditional healing from his father and grandfather, and has been practicing since 1961. Dr. Mylin asked when he is planning to retire, and Dr. Lomuno just laughed at the idea! Dr. Lomuno actually serves as one of the local chairmen of the traditional healers society (or cooperative or association, I forget what they called it). It was interesting to hear about how he goes to meetings to discuss practices and that they talk about regulating certain practices. He explained to us that the methods of traditional medicine can be used to hurt other people, and if they find that someone has done that, they label that person a witch doctor and remove his or her license to practice for 14 years. If they are found to practice during that time, he said that they could serve a prison term for breaking the probation period. He also had a logbook where he would record the people who came to visit him, and what treatment they received.

The tools of a traditional healer. The bottles contain crushed herbs from the bush, there is his logbook for patients, and his 'X-ray' that he uses to diagnose patients.

 

Dr. Lomuno has been practicing traditional medicine since 1961.

He then told us about the herbs that he has to treat a variety of illnesses and about which kinds of people he will refer directly to the hospital at Macha. The hospital staff (and Dr. Thuma) have talked with him over the years about how to identify patients who are dehydrated, have anemia or cancer and need to get to the hospital right away. Based on cases they have seen at the hospital where patients who had used traditional herbal remedies and overdosed, there has also been a good amount of conversation about the appropriate dose for patients so that adults and small babies won’t be given the same amount of the remedy. The students had many questions for Dr. Lomuno: how he diagnoses patients, his success rate, what he thinks of the hospital etc. Dr. Lomuno’s only complaint about the hospital was that although he refers patients to them, they never refer patients back to the traditional healers. 

This is the small grove of trees where Dr. Lomuno says many people are cured. This is where he talked with us about his practice.

Operating Theater and The Schools

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Day two of classes, and now we are starting to have individual (or smaller group) times in the operating theater, on rounds, at the schools, fixing oxygen concentrators or doing homework… The students in the operating theater this morning were exited to be able to see circumcisions, burn wounds, a woman having her tubes tied, and more circumcisions. Unlike in the US, most babies aren’t circumcised after birth, although one of the procedures the students saw today was on a baby. Instead, many of the procedures (and two that were done today) are on grown men. Recent research has shown that circumcised males have a lower rate of transmission of HIV, and in a country where HIV/AIDS is a major cause of death there has been a push to encourage circumcision of adult males.

Brandi getting ready for the operating theater

 

Caleb and Zak in the operating room. They observed two circumcisions.

Another group of students went to the local (public) primary school which has ~ 400 students enrolled in grades 1 – 9. Two notes on this: 1) The students enjoyed their time with the children, and had fun listening to the lessons, but they reported that one class had 50 students to one teacher (in a lower level class) and another class was left without a teacher (while the teacher was in a meeting) and were asked to work on an assignment. This isn’t terrible in and of itself, but does give an idea of how under-resourced the schools are here. 2) 400 students is a LOT for a little village in the African bush. The Headmaster told us that most of these students live with in a kilometer of the school. There is another, private, school not too far away that serves another 700 students who live within a 10 kilometer radius of the school. This is a HUGE number of children (and you may have noticed that there are many more children in pictures on the blog than adults. This is not just because kids are cute, but there really are many more of them). 

Annie, Keane, Stephne and Emily (and Brandi) at the school.

Annie having fun making funny faces with the school kids.

In class we were talking about population pyramids which represent the number of people who live in a region broken down by age. As you know the US has a big bulge in the population for the baby boomers, and then is relatively steady in population for lower ages (http://www.nationmaster.com/country/us/Age_distribution). In Zambia (http://www.nationmaster.com/country/za/Age_distribution) there is a huge ratio of children to adults, and very few elderly. This means that although there may not be that many adults or household in the African bush, there are LOTS of kids (we are hoping to get to know more of them during our home stays this weekend!).  Unfortunately this pattern of age distribution does not always translate into rapid population growth because the death rate is also very high in sub-Saharan Africa.

Keane being Keane with the kids.

Dan at School with the kids.

Thus we are all here to learn about Healthcare in the developing world! It has been very helpful to see Dr. Thuma’s perspective on the health problems faced by Zambians. We’ve been talking about what we can do to really make a difference in the lives of real people here in Macha. Certainly the 21 students won’t make much of a difference in two weeks on the spread of HIV in Africa. But we can focus on learning about the problems that are faced by people in this situation, and learn about what sorts of approaches have worked to make real change in the past. We can also show love to the people we are meeting and learning from while we are here. There have been many moments spent sharing a smile, showing our care for others, and sharing God’s love with those around us.  

Sunsets are quite the spectacle here!

Thanks to: Evan, Caleb, Preston, Caitlin, and Annie (and maybe others) for the photos today! 

 

First day of school

Today we started the lecture and book portion of the course. This morning Dr. Thuma talked about global health and the progress that has been made on the Millennium Development Goals (a set of goals established in 2000 with the goal of reaching them (globally) by 2015). Some of these goals are really relevant to our trip here: reduce child mortality (in the under 5 years category) by two thirds, reduce maternal mortality by three quarters (to read more about maternal health in developing countries check out posts at: www.rachelmariestone.com), and to reverse the spread of infectious diseases like HIV/AIDS, TB and malaria.

Emily and Evan studying today's lessons.

 I found the official content of the lectures quite interesting, but it is especially interesting to have Dr. Thuma’s personal experience added to the base information. He has been involved with caring for people here in Zambia for many years, and has seen many ways of approaching the problems facing the Millennium Goals personally. Thus he places a special emphasis on things that he has seen work in practice – specifically preventative measures in public health.  

The pharmacy at Macha hospital

After class and lunch we all dispersed to explore the area or arrange for the rest of our time here. After delivering the empty pill bottles and bandage wrappings sent from Grantham, we got a tour of the Pharmacy. Then Emily was introduced to the physiotherapist and was able to observe him for most of the afternoon. She saw patients with broken limbs, a club food, and a knee with osteomyelitis. Jess and others set up a time to go and observe the local primary and private secondary schools during the week (and played Ring around the Rosy, Simon Says, and Duck Duck Goose with many of the kids from the school). Other students found friends from the village and played football in their yards, or found the female soccer pick-up game and watched that. Other students joined the people waiting at the fires, and chatted (and danced) with them there. We are starting to feel more comfortable moving around and meeting people here in Macha, and will especially enjoy starting to go into the hospitals in the next couple of weeks.

Stephne and Jess playing with the kids at the primary school.

 

Sarah and Jackie dancing with a guy from the fires.

Other fun things: On Sunday we all took at walk to the Macha Dam, and took some fun pictures. 

ZAMBIA! (you may have to squint to make it work)

MACHA (again, squint or just believe us)

 P.S. For those of you who may be wondering why all of these pictures are tiny- we have all been learning that internet is not as easy to get in the middle of Africa as it is at Messiah (although the students tell me it's not bad by comparison). Bandwidth is especially expensive here in Zambia, and so we are only showing small pictures here, when we get back from the trip, we'll share nice big pictures with you all!

Sunday in Africa

Sunday in Africa (like in the US) involved a good amount of free time and relaxing. It started with a wonderful breakfast of pancakes before walking to the church. Our food here has been very good, even the self-categorized picky eater was saying that the food has been good. Lots of cabbage, chicken, rice, and fruit.  Tonight at dinner they had even made popcorn for us (which has served as dinner alone for me more than once, but they also had spaghetti for us).

Our group walking to church along the dusty road. We have a new appreciation for foot washing!

At the end of the day we were all reflecting on what we have most enjoyed about our first 48 hours in Macha. Nearly every student said that it is the people here. The people are so friendly and welcoming, the people are so joyful and happy - in the face of a hard life with few resources. The difficult thing is seeing how little the average person has in comparison to the wealth of resources we have available in the states. It was especially interesting to see that the students are struggling with realizing the disparity of wealth with the people here in comparison to ourselves after only two days, and that the missionaries who grew up in the country and have served here for years are still struggling with this same thing. Perhaps there are some things that are very difficult to deal with, very hard to grapple with in our minds, and there is no solution that we can give. We are simply asked to do our best - knowing we are not the solution, and that there may not be a solution. This does not mean we should do nothing – but that we should do what we can with the Love and Joy that God gives as we do what He has asked of us.  

Andrea holding one of Gideon's Grandkids.

Amanda showing kids a video of them dancing the chicken dance on her camera.

A side note on Joy:  Church this morning was very fun. The music and singing were joyous and beautiful (and with a phonetic language we could sing along with words we did not know), and the sermon was about… Subtraction! (By the way- I love math- but the pastor talked more about the spiritual aspects of subtraction.) My two favorite parts of the service were 1) the special music by the local girls school (a boarding school) singing a beautiful song accompanied by drums, and 2) when the pastor and his interpreter got the giggles during one of the translating moments!

All of us at the Macha District Brethren in Christ Church

After Sunday Dinner (chicken and potatoes) we took a group walk to the Macha Dam, Gideon’s shop, and to the local soccer match. At Gideon’s shop many of us purchased fabric chitenges like the women wear and use here (some students even got ones decorated with Bob Marley). We played with the kids, and played with the adults (a checkers like game). Finish it off with a Soccer match (we’re pretty sure the Macha Sparrows won) and some Duck, Duck Goose (sorry Minnesotans, I can only teach them so much here, so no Gray Ducks), for a perfectly fun Sunday in Macha!  

Playing Duck-Duck- Goose with the kids. Apparently, they didn't get the idea of tapping your head, but instead wacked it if you were goose ;)

Macha Sparrows vs Someone else- can you spot the barefoot players?

PS. Thanks Evan for the photos.

The Fires: a glimpse into real life in Zambia

After our interesting morning tour of the hospital campus, we went back out this afternoon to explore the village beyond the Hospital complex. Here we visited a place called 'The Fires,' there are no hotels in Macha, so this is where the family a hospitalized person will stay until they are able to take their family member back home. This is also where many women come when they are 8 and 1/2 months pregnant, to wait for the baby to be born near a hospital. One woman we spoke to with a very young baby had traveled 100 km (possibly more) to stay near the hospital until her baby was born, and then she was staying there until she was ready for the very long walk home.

Women at the Fires, note the swollen bellies of the pregnant women.

The area is called the fires because there are many small fires burning throughout the day as women from each family are making food for those waiting and for their family member in the hospital. I've included some pictures that we took when we visited there below. You can see that people are out in the open, but that there are roofs in some areas, and buildings as well. This is not official hospital grounds, so the water may not be safe (although there is a well nearby) and no one is caring for sanitation in this area, thus the conditions are not good, but, Dr. Thuma reminded us, are not that different than what these women are used to at home.

Mitchell with women from the fires.

Emily showing the women their pictures

Nevertheless, the people there were all very friendly, and all greeted us as we walked by. There were several women braiding other women's hair into a variety of interesting patterns. We stopped to look and took some pictures, which we showed to the women. Imagine living without a single mirror in your town, with muddy water, and with no nice shiny glass windows (much less not looking at yourself in the mirror 5 times before you leave the house in the morning). This is reality for these women who have very little idea of what they look like, so seeing a picture of themselves is one of the very few times they would have seen their own face! They LOVED it! Everyone wanted their pictures taken and then immediately to see the picture. Some of the students even took videos (with their cameras) of the women and showed them- the women were amazed, and we had a really fun time.

Me showing a picture to a women at The Fires (in the back you can see the fire)

 On the way home we walked past the well and saw women getting their water for the day, 20 gallon buckets full of water easily hoisted to their heads and carried back to the village. The lives of the women are very labor intensive in the villages. The lives of little boys are more filled with soccer, Evan and Michael decided to help them out with that!

Evan and Michael playing soccer with some boys.

Settling In

Today is our first full day in Macha. It is especially quiet here today since many people are not working because it is African Freedom day. Maybe we won't all oversleep (like we did this morning) once there is activity starting early in the morning outside our windows.

The whole group of us in Macha!

It can be somewhat intimidating to be told to just go exploring and see what you find. We often worry before going out into a new area that there may be dangerous or unfriendly things, creatures or people. The area around Macha is very safe. There are no poisonous bugs (although there are these super cute fuzzy caterpillars (not for eating) that will irritate your skin and other biting bugs but they aren't going to kill you!), and everyone we have met has been very friendly and welcoming -- but you don't know that until you go out and see the area yourself. In order to help us begin feeling comfortable going out and about in the area, and to help us get a feel for the layout of Macha Research center and the surrounding area Dr. Thuma took us on a walking tour around the hospital and research buildings this morning, and to the village market and a place called the fires this afternoon.

The hospital buildings were build by Dr. Thuma's father in the 1950s, and Dr. Thuma grew up here in Macha. Since then they have added many extra buildings and have specialized Children's wards, OB ward, HIV, Men's and Women's ward (and more). The students will be spending a good portion of many of the upcoming days in the operating theater or doing rounds in the hospital and will come to know the campus well.

Stephne and Emily at the Children's Ward

Visiting hours are strictly enforced for most of the wards, the exception being the children's ward. Each child is accompanied by a parent (or other adult) who traveled with them to the hospital and will help the few nurses with caring for the child. The Children's ward is the only one we were able to really see today on our tour (our group is too big) but we were able to see two interesting things. 1) Instead of having tanks of oxygen for weak patients, they use an oxygen concentrator here. Steven Bandstra, the Messiah Mechanical/Biomedical Engineering graduate on our trip brought along supplies from the Collaboratory to fix the concentrator for the hospital. 2) One wing of the children's ward has recently been closed. Termites are a BIG problem here (individual termite mounds can be 2 meters high and as wide across!) and they have severely damaged the roof of the children's ward requiring closing one room, and the need to replace most of the roof on the entire children's ward.

The recently evacuate Children's Ward room. The roof needs to be replaced because of termite damage.

We also saw the outside (but not the inside) of the research buildings where they have ongoing projects to study Malaria, HIV and TB. Many of the buildings are decorated with painted trim near the roof to help to distinguish the many red brick buildings from one another. The Research Trust buildings are decorated with my favorite thing: DNA!

That's only 1/2 our day! - but it's time for dinner and I need to hunt down some of the pictures the students took to explain the second part of our day.

Home (for now)

Today was the last leg of our journey from Messiah to Macha. We started out full of hopeful expectation, with some uncertainty about what we were getting ourselves into. Along the way we have gotten to know ourselves and each other a bit better. Not only did we learn how we respond to days of travel with fitful sleep, we also encountered our own stink in a way usually not required of us. I learned that it is tricky for me to think through unexpected changes to the plan when I was depending on someone else to think up the plan - and also that many people here in Zambia are kind and generous, and that the students are dependable, caring, and willing to be flexible, play things by ear, and try new things (like caterpillars for dinner!).

Preston eating a fried caterpillar, Zach looking grossed out!

We learned other fun things about each other: what kinds of movies people like to watch on planes, whether they snore, if they are willing to eat caterpillars for the experience of it (AND whether they LIKE eating caterpillars), how adventurous people are (whether they are willing to dance with the Zambian performers). We learned more once we arrived in Macha when Dr. Phil Thuma asked the students to give one word they would use to describe themselves. We have students who are self described as: social (and sociable), fun, shy, planners, laid-back, interesting, efficient, complex (and much more - I wish I had written them all down) it will be fun to get to know this aspect of each other during the next couple of weeks.

Now that we are here at Macha, the exhaustion that began to cloud our hopeful expectation is being replaced anew with hopeful expectation. We will tour the research institute and hospital tomorrow, and also tour the village and market. We have already met some Macha residents who warmly welcomed us to the village. This includes some kids who were more than willing to entertain a group of students with impromptu volleyball. I know the students are hoping for more of these fun and relaxing times with the kids during the coming weeks.

We have much to learn and much to see! Arriving in Macha has made part of what we had hoped for real, and now we are ready to dig in and experience what we came here to learn.

It's Thursday (?) night and the students are relaxing in the pillow den at Jollyboys waiting for dinner. This is a definite upgrade from waiting in Airports and in lines and sleeping on a plane. The students have been GREAT on the trip- no complaining, and VERY helpful when I was trying to think on my feet after ~ 3 days of little sleep and no showers.  We have already enjoyed some Zambian hospitality, checking out the shops in Livingston, and are looking forward to having our eyes fully open (after sleeping in BEDs tonight!) while encountering the countryside on our bus ride to Macha.

 Parents: the students all wanted to know if I had told you that they are all well. You (the parents) are regularly in our conversations: "My Mom would LOVE that" etc. You are not far from the students thoughts.

 Love from Zambia to you all!

Pillow Den at Jollyboys

Jess found a friend!

Much needed rest for our feet.